In a large study of men in Japan, the presence of fatty liver disease by ultrasonography showed an inverse ( reduced risk) association with the frequency of moderate alcohol consumption; however, there was some suggestion of an increase in fatty liver disease with higher volume of alcohol consumed per day. Moderate drinkers had lower levels of obesity than did non-drinkers, and both obesity and metabolic abnormalities were positively associated with fatty liver disease. These findings support the results of a number of other recent studies showing that moderate drinking does not increase the risk of this common type of liver disease; instead, it is associated with a lower risk of its occurrence. We agree with the implications of these studies as stated by the authors: "These results suggest that lifestyle modifications aimed at fighting central obesity and metabolic abnormalities should be the most important recommendations for the management of fatty liver. In addition, it seems unlikely that the risk of fatty liver can be reduced by the discontinuation and/or reduction of alcohol consumption alone."